Introduction
Psychotherapy has gradually evolved during the past few decades closing the bridge with the medical world. Increasingly, studies are stressing on the biological substrate evidenced in human disorders. It has been claimed that neurological or chemical mechanisms are responsible for the disorder. On the other hand, Biopsychology has come forward purporting to offer a lasting solution by providing something that is seen and touchable other than basing treatment on meaning and interpretation. Medical practitioners have also not been left behind who now offer medication as the best option.
This obviously conflicts with psychotherapists as it has brought the world of depression treatment to a whole new world in which they are not well orientated. Being told to trade of the uniquely structured interpersonal phenomena of the usual therapeutic process with a medical-diagnoses model does not sit well with them. With all these foregoing, this paper seeks to understand an integrated psychotherapy and pharmacotherapy process in the treatment of depression.
Etiology of Depression
Definition
The World Health Organization (WHO) has defined depression as “a common mental disorder that presents with depressed mood, interest loss or pleasure, thoughts of guilt or low sense of worth, disturbed sleep or appetite, low energy, and poor concentration” (WHO, 2012). The common definition is that, it is a psychological disorder which harms personality feel, bodily performance of one’s body and the way they interact, (The World Christian Community, 2012). Academicians view it as an illness and consider it as resulting from physical, as well as psychological factors.
Causes, Incidences and Risk Factors
The exact source of depression has not yet been identified, (ADAM, 2012). But the causes and symptoms of depression can greatly vary. In order to carryout an informed treatment of depression, it is crucial for the professional involved to understand its root causes for the particular patient he is handling, and begin his treatment procedures from a point of sound understanding of the issues involved (LaHaye, 1974). There are different treatment protocols that could be followed. This depends, mostly, on the fundamental philosophy that any medical or psychological professional wishes to use.
Depression could last from a few weeks to years if treatment is not sought promptly and should not be ignored as a slight personal weakness where individuals believe they will be able to overcome in due time.
Symptoms
Depression is characterized by a range of symptoms. These include; loss of interest in virtually everything in life, loss of appetite, insomnia, weight loss or weight gain, always anxious or suffering from low moods, concentration problems, irritability, etc. Individuals suffering from depression will usually associate themselves with feelings of guilt, hopelessness, worthlessness or helplessness. Physically, these individuals will complain of headaches, chronic pains, and digestive disorders and are unusually fatigued.
There has been arguments by scholars that these symptoms differ with gender where men and women exhibit dissimilar signs. According to Addis, author of Gender and Depression in Men, “Men [are] characterized by lack of satisfaction, suicidal ideation, work inhibition, somatic problems, and indecisiveness” (Addis, 2008). According to him, these are different from those of women who portrayed “…more self-dislike, crying, distorted body image, fatigability, and irritability.” (Addis, 2008).
Signs and Tests
Most academicians’ view of depression from a medical point of view and approaches it with the idea that it is a sign of an illness; Just like any other physical illness which can without doubt be tested and treated through scientific procedures. In fact, protocols on how depression can be treated have already been formulated from a medical model. They have labeled it a mental illness (Karp, 1996), and even modern organizations such as the American Psychiatric Association and the National Institute of Mental Institute have affirmed this position (The World Christian Community, 2012). It has also been agreed that factors causing depression could result from both psychological and physical experiences.
The standpoint that physical aspects contribute to the occurrence of depression either as the result of or as causative factors has created a conflict between the secular world view and that of their counterparts, the Christians. The secular world views depression as any other illness which renders man as incapable of effectively dealing with the resulting symptoms and the entire “disease”. But the Christian world view does not think so.
Treatment of Depression
There are various treatment methods for depressive disorders. Research has shown that different treatment methods produce different results and, therefore, a careful selection of the most appropriate treatment is crucial for the patient. Authors believe that there are diverse depressive disorders and each disorder should be treated using its own unique treatment method. “For example, depressions whose origin is biological such as; Melancholic depression, bipolar depression and psychotic depression will most likely be resolved through physical treatments instead of using psychological treatments alone” (NIMH, 2008).
Psychotherapy
Psychotherapy provides different tools and various angles through which depression can be treated. Different types of psychotherapy are available. There are those concerned with helping one adopt some practical strategies on methods they can use to reframe their way of thinking and practice on new behaviors that will assist them in suppressing depression. “Therapy also helps identify the cause of the situation, and assists one in understanding why they feel the way they do, what triggers depression and ways to avoid it” (Brown et al., 1997). We shall discuss the few types of psychotherapy:
Talk Therapy
It is also referred to as Narrative Therapy. Talk Therapy usually involves the therapist constructively listening to the patient narrates their life experiences and the manner in which he describes his life. He then identifies how the patient’s perception of himself and his life he may limit or restrict himself in overcoming life challenges. It assists the patient to recognize the range of capabilities, skills and potentials he already possesses and is not aware of and which he can maximally utilize to overcome his difficult situation.
The unique character of this type of therapy is that is focuses on identifying an individual’s strength and capabilities. Then it compels such individuals to master these strengths and capabilities and employ them in battling with life problems. It helps the individual build on his resilience instead of living his life focusing on the negativities he encounters.
Cognitive Behavioral Therapy (CBT)
“Individuals suffering from depression usually possess a persisting negative view, of themselves and the world they exist” (Leisechsenring, 2001). This negative mindset is an analysis of their way of thinking about life. This negative pattern of thinking becomes so deeply entrenched in them that they cannot even tell when they are making errors of judgment, (Brown et al., 1997). Their way of thinking is so irrational that they are incapable of assessing ordinary issues in a balanced approach.
CBT comes in to pinpoint to people how their negative thinking patterns impacts on their moods and how they can escape these negative thoughts. This method is premised on the idea that negative thinking is a habit which can be driven away. Patients are forced to adopt a positive way of thinking.
Psychotherapies
This method goes on for an extended period so as to create an intimate and personal relationship between the patient and the therapist. With a strong personal relationship existing between the two, it becomes possible to explore aspects of the patients past experiences in great depth, which would enable the therapist understand what could have led to the current situation (Schade, et al., 2005). Establishing a link between the past and the present is believed to, not only resolve the current depression, but it also leaves the patient less vulnerable, (Schatzberg, 2006), to future possibilities of contracting depressive tendencies (Markowitz, 2008).
Joining a Support Group
In group therapy, one is able to listen to other people who may be going through the same situation and this helps them to identify with others. It makes one realize they are not struggling alone and makes them stronger in facing their experiences. Through sharing and speaking out, one is able to identify some of the ways to overcome his problem, which may have worked for the other members of the group. Also, since most patients usually have problems in their social interactions, attending group therapy increases their opportunities of engaging in many social activities and social networks through which they can express their thoughts, ideas and frustrations.
Other Treatments
Electroconvulsive Therapy (ECT)
If properly prescribed and administered, ECT performs very well in the treatment of certain psychiatric conditions, including; psychotic depression, severe mania, severe melancholic depression, and severe postnatal depression. This method is also relatively safe because anesthetics are used so as to ensure that the possible short-term side-effects are greatly minimized.
Transcranial Magnetic Stimulations (TMS)
This method is still undergoing research to identify its possible utility in the treatment of depression. It has been suggested that it could be a viable alternative to ECT though, but no evidence supporting this has been obtained yet.
Medications Psychotropic
Psychotropic medications are medications used to treat persons with mental disorders such as depression, schizophrenia, bipolar disorder, and anxiety disorders (Thase & Sachs, 2000). They may be administered together with psychotherapy and depends on the patient’s individual needs and circumstances (Saisan, et al., 2012). They are called antidepressants.
Antidepressants
This category is made up of several families. Each antidepressant performs a different role and varies in its effectiveness. Particular types of depression require specific types of antidepressants. Therapists are advised to get to first know the type of depression the patient is suffering from, so as to be able to determine what the possible causes are and identify with his patient in order to come up with the best medication to use. Different treatment plans (algorithms) exist for the particular type of depression.
The most common types of antidepressants are known as Selective Serotonin Reuptake Inhibitors (SSRIs). They include; “Paroxetine (Paxil) Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro), and fluxetine (Prozac)” (NIMH, 2008).
“Another antidepressant commonly used is the bupropion” (Wellbutrin) (NIMH, 2008). This is used on the neurotransmitter dopamine and cannot be categorized into any class of drugs. SSRIs and SNRIs are well renowned due to the fact that they do result into many side-effects as was the case with previous classes of antidepressants. Also, “classified as antidepressants are Tricyclics, monoamine oxidase inhibitors (MAOIs) and Tetracyclics. Some people consider these as the best medications” (Counseling Center, 2012).
Some of the known side-effects of antidepressants include; headaches, nausea, sleeplessness or drowsiness, agitation, reduced sex drive, etc. Trycyclic antidepressants are known to cause; dry mouth, bladder problems, constipation and blurred vision among those aforementioned. Individuals using antidepressants should adhere to their doctor’s instructions to avoid these side-effects (Leise, 2001).
When one medication does not produce results, it is advisable to try another one. According to a study named STARD, “if a person with difficult-to-treat depression did not get better with a first medication, chances of getting better increased when the person tried a new one or added a second medication to his or her treatment” (Trivedi, et al., 2006).
Integration of Theology, Psychopharmacology and Psychotherapy in the Treatment of Depression
Integration of Pharmacology and Psychotherapy in the Treatment of Depression
It has been argued that treatment of depression by combining pharmacotherapy and psychotherapy leads to reduced chances of failure in treatment (Sparks, et al., 2006). Nevertheless, according to the Powers who has authored Psychotherapy and Pharmacotherapy in Depression, he was of the opinion that the probability of failure has nothing to do with the amount of psychotherapy received while higher doses of pharmacotherapy increases chances of success. Thus, continuing to see a psychiatrist does not guarantee successful treatment and may, in fact, lead to failure, (Hesse, 2009).
This opinion was based on the results of a research he conducted in this area which revealed “an additional prescription for antidepressant medication reduces by 5% the likelihood of treatment failure, but the amount of psychotherapy does not affect treatment failure” (Powers, et al., 2002) He, therefore, advises patients of depression to visit a properly identified and carefully selected psychiatrist. This, he says, “appears to reduce the likelihood of treatment failure” (Powers, et al., 2002). He also suggests that coordinated care can be very beneficial to the patient. According to his work, case management has been known to have a positive effect on the amount of pharmacotherapy which in turn increases the chances of treatment failure.
Integration of Theology in Treatment of Depression
Studies have identified an inverse correlation between depression and spirituality. Despite this, there exist various impediments in the attempted integration of spiritualism in the treatment of depressive tendencies. Some of these are ideological bias, lack of common frameworks for the integrated treatment, the inexperience of spiritual service providers, specialization and fragmentation of the two fields, all of which have the effect of resulting into two severed parts of a presumed whole (Barnett & Johnson, 2011). Thus, a way should be found to overcome these obstacles if these two fields are to come together and work in harmony which is the desired effect (McCullough & Larson, 1999).
Theology on its part may impact heavily on the way a depressed individual thinks about the whole situation. Some patients may resist treatment because they feel that their problems are as a result of their diminishing faith (Koening, 2005).
Some religious traditions will describe depressive disorders as indicative of spiritual weakness or even as a punishment “from above”. On the other hand, professionals will be quick to ignore the spiritual dimension of the problems being experienced by their patients. According to Peteet, “some view spirituality as an epiphenomenon of more basic neurobiological or evolutionary processes and as such of only peripheral interest in psychiatrist” (Peteet, 2012). This kind of thinking bars them from appreciating their patient’s traditions and spiritual orientations and, therefore, missing in this crucial link to place their patient within a greater sphere beyond themselves, be it spiritual or cultural.
In light of all this, a consensus has not been arrived at on “how best to approach the intertwined emotional, existential, and spiritual dimensions of patient’s depressive concerns” (Peteet, 2012). Nevertheless, clinicians should consider a wide range of diagnostic categories and the diverse interests arising in situations of depressive disorders. They should appreciate the existential dimensions of these interests, and how they cause emotional distress and incorporate corresponding beliefs and necessary spirituality in their treatment procedures (Blazer, 2005), so as to offer an individualized, comprehensive treatment to depressed patients.
Conclusions
It is possible to have integration of psychotherapy and pharmacotherapy in the treatment of depression. Psychotherapy too should not be left behind, and while they are at it, therapists should take time to get to know the spiritual convictions of their patients and incorporate them in their treatment procedures.
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